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SSS <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUM, FEE DUE: <br />COUNTY: <br />Montrose County <br />M-1987-151 <br />Soderquist Pit <br />October 28, 2004 <br />i~ ~ <br />/~~ <br />RECEIVED <br />SEP 2 72004 <br />Givision of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Montrose <br />According to C.R.S. 34-32.5-116 or C.R.S, 34-32-116, each year, on the anniversary date of the permit, an <br />operator shall submit the annual fee, a report andsnapshowing-the-extent-o~cmrent-dishrrbance'; to-affected <br />land, reclamation accomplished-to-date. and during the preceding-year, new disnubances-that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the yeaz, if any. <br />Please attach y~nnr revised written annnal rep_nrt and anmral rgpprt map fn this form. Please n0[e that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following pennittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Brian Wilson <br />Permittee Name: Montrose County <br />Address: 161 S. Townsend <br />Montrose, CO 81401 <br />Phone Number: (970) 249-7755 9 70 - a 5 ~ - 700 7 <br />Fax Number: (970) 249-7761 % 70 - ,~ ~~ D /(I <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />S~ r f Corporate Officer, Owner, or Designee <br />~/~~ /~y- <br />Date <br />M:~PERMITNIASTERDOCUMENTS4~I-AF-04 <br />